Endocrine Dz Peds

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What is negative feedback?

Increasing the levels of a specific hormone to inhibit the system responsible for releasing that hormone

Fill in: Hormonal control of many body functions are not fully developed until ___ months of age. This will cause fluid imbalance, amino acids and glucose too.

12-18 months

This term uses a scale that defines physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitals, testicular volume and development of pubic hair.

Tanner Staging

Which foods are needed to avoid with someone who has PKU (Phenylketonuria)?

Milk

Eggs

Cheese

Nuts

Soybeans and Beans

Chicken, beef, pork, fish

This is a disorder of the adrenal glands where there is a lack of enzymes to make the hormones, CORTISOL and ALDOSTERONE. What are the physical findings in boys? Girls?

Congenital Adrenal Hyperplasia (CAH)

Boys: early development of male characteristics, growth problems

Girls: ambiguous genitalia, failure to to menstruate, growth problems

What serum levels will you look for with CAH and other tests?

What is the treatment?

(CAH: disorders of adrenal glands where there is a lack of enzymes to make the hormone cortisol and aldosterone)

Serum renin ad cortisol levels

X-rays (bone age) and newborn screen

Tx: Hormone replacement

- Glucocorticoid (hydrocortisone acetate, cortisone acetate)

- Mineralcorticoid (Fludrocortsone acetate: FLORINEF)

Fill in:

Most common for of CAH, manifests around this time of life, __a__.
With CAH, the low mineralcorticoid production can result in __b__.

a. early weeks of life

b. renal salt wasting

Renal salt wasting can be caused by what disorder?
What three things can result from renal salt wasting?

Can be caused by CAH (Congental Adrenal Hyperplasia)

1. Hypovolemia - hypotensive crisis/shock

2. Hyponatremia - risk for seizures

3. Hyperkalemia - risk for cardiac dysrhythmias

List treatment methods for CAH (congenital Adrenal hyperplasia)

1. Prompt fluid/electrolyte management

2. Oral glucocorticoid and mineralocorticoid replacement

3. FLORINEF for replacement therapy

4. Hydrocortisone if vomiting

With Diabetes Insidipus, will production of ADH increase or decease if serum osmolarity is low? What will this cause?

Low serum osmolarity = Decreased ADH

- Causes increased urine output

With Diabetes insipidus, will ADH production increase or decrease when serum osmolarity is high? What can this cause?

High Osmolarity = increased ADH

- This can cause increased water retention and decreased urine output

Match:

1. ADH deficiency
2. Kidneys insensitive to normal ADH levels

a. Central DI
b. Nephrogenic DI

1. a

2. b

What is central DI and what are its causes?

Central diabetes insipidus is a form of DI that occurs when the body has a lower than normal amount of antidiuretic hormone (ADH).

It involves extreme thirst and excessive urination.

- Causes: Head trauma, tumor, infection of brain, brain surgery

What is Nephrogenic DI?

In nephrogenic diabetes insipidus, the kidneys produce a large volume of dilute urine because the kidney tubules fail to respond to vasopressin (antidiuretic hormone) and are unable to reabsorb filtered water back into the body.

Fill in:
Children who have had surgery involving the hypothalamus or pituitary will first exhibit a transient __a__, followed by a permanent DI.

SIADH

T or F: SIADH can be transient and will resolve on its own

True

What is the tx for SIADH

Correcting lytes, mainly the diluted serum sodium

- fluid restrictions

- Possible NaCl infusion

State whether these are DI s/s or SIADH

1. Decreased urination
2. Increased urination

3. Fluid loss
4. Fluid retention

5. HYPOnatremia
6. HYPERnatremia

1. SIADH (decreased urination)

2. DI

3. DI (fluid loss)

4. SIADH

5. SIADH (HYPOnatremia)

6. DI

State whether this is s/s of DI or SIADH

1. Increased serum osmolality
2. Decreased serum osmolality

3. Decreased urine osmolality
4. Increased urine osmolality

1. DI

2. SIADH

3. DI

4. SIADH

This drug is a man-made form of a hormone that occurs naturally in the pituitary gland. This hormone is important for many functions including blood flow, blood pressure, kidney function, and regulating how the body uses water.

A pt. with goiter, increased appetite, weight loss, and tremors might have this

HYPERthyroidism

What is this term: Premature appearance of secondary sex characteristics, accelerated growth rate, and advanced bone maturation (Before 8 in girls, and 9 in boys)

Precocious Puberty

Precocious Puberty occurs before ___ y/o in girls, and ___ y/o in boys.

Girls: 8

Boys: 9

Premature closure of epiphyseal plates can limit adult height. At what age for girls and boys is premature?

Girls: 14

Boys: 17

T or F: Children with precocious puberty often appear older than their chronological age.

True: they are treated so with unrealistic developmental expectations

Fill in: Elevated LSH and FSH in young adolescents may indicate this ___.

Precocious Puberty in girls

- Increased Testosterone in boys

What is med tx for Precocious Puberty?

GnRH agonist/blocker (central)

List the glucose goals for each of these types of children:

1. Non-diabetic children
2. Children with T1 DM
3. Infants and toddlers with T1 DM

1. 70-110

2. 90-180

3. 100-180

When mixing two different type of insulin in the same syringe, and after injecting air, will you withdraw from the short-acting (clear) insulin first, or the intermediate-acting (cloudy) insulin first?